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Coalition Condemns 75% Rule on Inpatient Rehab, Urges Enactment of Stopgap Legislation Washington, D.C. - Today, the Coalition to Preserve Rehabilitation (CPR) is pleased to participate in a Congressional Briefing on the harmful impact of Medicare’s 75% Rule on access to inpatient rehabilitation. CPR Steering Committee member, Anne Sommers, J.D., of the American Association of People with Disabilities (AAPD), will offer her personal remarks at the event. The CPR is a coalition of national consumer, clinician, and membership organizations with the goal of preserving access to appropriate rehabilitation services so that individuals with disabilities, injuries, or chronic conditions may regain and/or maintain their maximum level of independent function. Currently, Medicare is phasing-in implementation of the so-called “75% Rule” as a means of qualifying inpatient rehabilitation hospitals and units for reimbursement purposes. The rule requires that facilities maintain a 75% census of patients with one or more of 13 conditions, thus forcing inpatient rehabilitation facilities to manage the mix of the patients they treat based on an arbitrary qualification rule, rather than on individual need for rehabilitative care. “The impact of the 75% Rule essentially amounts to a quota system that determines who can and cannot receive intensive rehabilitation services,” stated Judith Stein of the Center for Medicare Advocacy, Inc. “Medicare coverage is based on legal standards; if people with Medicare qualify for inpatient rehabilitation services, they are entitled to such services and to Medicare coverage. A beneficiary should not be denied access to reasonable and necessary care or to Medicare coverage based on arbitrary rules or quotas,” she continued. CPR members point out that the intensive and coordinated care received in inpatient rehabilitation facilities allows individuals with injuries, disabilities and chronic conditions to regain maximum independent function and return to their homes and communities. Despite recent reports that nursing homes are comparable to inpatient rehabilitation hospitals and units, CPR members do not agree. “In an inpatient rehabilitation facility an individual’s entire rehabilitation team is present, working and planning with you to regain function and eventually, independent living,” stated Anne Sommers of AAPD. “Medicare requires that these facilities provide individuals with intensive, multidisciplinary therapy as well as extensive medical management. For individuals requiring that level of rehabilitative care, a less intensive setting, such as a nursing home, is not appropriate.” Legislation has been introduced in both the House and Senate (H.R. 1459/S. 543) to freeze the rule at its current threshold of 60 percent, preventing a scheduled increase on July 1, 2007. While it is not a complete repeal of the rule, CPR members strongly support the legislation as a temporary solution to an increasingly harmful restriction. Ms. Sommers concluded, "We urge Congress to enact the 'Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007’ prior to July 1, 2007 to ensure that further implementation of the 75% Rule does not cause greater restrictions to inpatient rehabilitation and, thus, limit the ability of people with disabilities, injuries, and chronic conditions to return to independent living." May 9, 2007 U.S. State Senate The undersigned members of the Coalition to Preserve Rehabilitation (CPR) write to express our profound concern with the current Medicare rules that are having the effect of restricting access to-and diverting Medicare and other patients away from-intensive, coordinated rehabilitation services provided in inpatient rehabilitation hospitals and units. Restricting access to medically reasonable and necessary inpatient rehabilitation services adversely impacts beneficiaries' health, functional status and quality of life, particularly their ability to return to their homes and families, possibly regain employment, and live as independently as possible. Beneficiaries should not be forced into inappropriate placements in nursing homes. CPR is a coalition of national consumer, clinician, and membership organizations with the goal of preserving access to appropriate rehabilitation services so that individuals with disabilities, injuries, or chronic conditions may regain and/or maintain their maximum level of independent function. By way of background, the Centers for Medicare and Medicaid Services (CMS) is phasing-in implementation of a rule (commonly referred to as the "75 Percent Rule") as a means of qualifying inpatient rehabilitation hospitals and units for reimbursement purposes. The rule requires that facilities maintain a particular percentage of patients receiving treatment for one or more of 13 conditions specified by CMS. Practically speaking, in order to retain their qualifications as an inpatient rehabilitation hospital or unit, some of these facilities are forced to establish healthcare quotas, i.e., they must manage/limit the mix of the patients they treat based on the 75% Rule rather than on the basis of clinical judgment and rehabilitation need. In other words, these facilities are being forced to deny medically reasonable and necessary inpatient rehabilitation services to beneficiaries who meet strict admission criteria, but who do not happen to have one of the thirteen conditions on the list. CPR believes that this is completely inappropriate and that rehabilitation hospitals and units should not be put in this position by a bureaucratic policy. Recent reports suggest that nursing homes are perfectly capable of treating patients in need of in of intensive and coordinated rehabilitation care and that nursing homes are appropriate even when patients have serious medical complications. As an article in the Atlanta Journal Constitution recently stated, "nursing homes have spent millions of dollars on renovations and additions and new features like aromatherapy, brightly colored decor, spacious therapy gyms, and Internet cafes to try to create a new, warmer, less institutional image." Brightly colored decor and internet access are pale substitutes for the comprehensive medical and rehabilitation services provided in inpatient rehabilitation hospitals and units. For example, in order to be considered an inpatient rehabilitation facility under Medicare, an entity must meet stringent criteria, including the provision of intense, comprehensive, coordinated care by a multi-disciplinary team of healthcare professionals who specialize in the medical, physiological, and psychosocial aspects of rehabilitative healthcare. Rehabilitation physicians and rehabilitation nurses must be available on a 24-hour basis and a physician must see the patient every two or three days. In general, Medicare requires that inpatient rehabilitation facilities provide individuals with intensive, multidisciplinary therapy as well as extensive medical management. The facility must have a medical director of rehabilitation with specified training/experience. In contrast, in skilled nursing facilities, there is no requirement for interdisciplinary team conferences or coordination among therapists; there are no minimum requirements for the amount of therapy provided; physician visits are required once every 30 days (and once every 60 days after the first 3 months); and patient assessments are required quarterly or within 14 days of a significant change in te patient's status. To equate these two levels of care is fundamentally untenable. Access to intensive, coordinated rehabilitation services provided in inpatient rehabilitation hospitals and units for beneficiaries covered by Medicare and other payers is often the lifeline from a debilitating injury or illness back to maximum function in one's home and community. Longer term placement in a nursing home simply does not compare. CPR believes that medical and rehabilitative need alone should determine which patients have access to inpatient rehabilitation, not arbitrary rules that define what constitutes a rehabilitation hospital or unit. However, in the absence of a better mechanism to achieve this, CPR certainly believes that Rule should not continue to be phased-in, as is currently planned on July 1st, causing greater restrictions in access to inpatient rehabilitation. That is why the undersigned members of the CPR support the Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007 (S. 543). We strongly urge Congress to take immediate action and pass this legislation before July 1, 2007 to ensure that the 75% Rule does not continue to inappropriately deny beneficiaries access to inpatient rehabilitation services needed to maximize their independence and return to their homes and communities. Thank you for your consideration. Sincerely, American Association of People with Disabilities |
